DESCRIPCIÓN DE INDICADORES

The review suggested that in the last twenty years, there is a clear momentum and

engagement to drive forward greater and enhanced mental health support service provision at the post-secondary education level (CACUSS & CMHA, 2014; CMHA, 2014a; Clarke et al., 2003; MacKean, 2011; Ministry of Training, Colleges and Universities, 2014; Ontario College Health Association, 2009). This drive has given way to a considerable growth in the literature on college and university student mental health. In particular, the number and diversity of mental health policies and practices noted confirms that this topic is becoming a priority for relevant theorists and practitioners (CACUSS & CMHA, 2014; CASA, 2014; CMHA, 2014a; Kay & Schwartz, 2010; Kadison & DiGeronimo, 2004; MacKean, 2011; Martin, 2010; Ontario College Health Association, 2009; Quinn et al., 2009; Sharp et al., 2006). Additionally, researchers in this area of study have also demonstrated an understanding of the existing barriers that (im)mobilize mental health policy and practice within academic settings (Anderson et al., 2007; Brener et al., 2007; CACUSS & CMHA, 2014; Cavalheiro et al., 2012; Cornejo, 2010; Han & Weiss, 2005; Ontario College Health Association, 2009; Reupert & Mayberry, 2007a; Santor et al., 2009: Statham, 2004; Stone et al., 2000; UMCMHS, 2014). A continued interest in this area can encourage researchers to establish strategies on how to overcome the immobilizing elements, or conversely, foster the mobilizing ones.

Despite the contributory advancements of existing scholarship, several shortcomings were inevitably apparent. First and foremost, there was a paucity of scholarly research that investigated student mental health at the Canadian post-secondary level, as similarly recognized

in MacKean (2011) and CASA (2014). MacKean’s (2011) literature and environmental scan of mental health and well-being in Canadian post-secondary settings appeared as the only known recent publication that closely examined student mental health in Canadian post-secondary institutions. Frado’s (1993) Learning Diversity: Accommodations in Colleges and Universities for Students with Mental Illness appeared as another publication that closely examined post- secondary student mental health in Canada. However, her work was published more than twenty years ago; much has changed with respect to mental health since then. Other Canadian-based resources that explored mental health at the college and university level seemed to draw from government and organization policy/strategy documents, as well as media releases (CASA, 2014; CMHA, 2014 a/b; Cavalheiro et al., 2012; Lunau, 2012; Ontario College Health

Association, 2009). CMHA’s (2014a) recent publication, A Guide to College and University for Students with Psychiatric Disabilities, as well as CACUSS and CMHA’s (2014) Post-Secondary Student Mental Health: Guide to a Systemic Approach, are two noteworthy examples of policy documents that discussed mental health in Canadian post-secondary institutions. Hanlon’s (2012) article “State of Mind: Addressing mental health issues on university campuses” in University Manager magazine, as well as Lunau’s (2012) article “Mental health: the broken generation” in Maclean’s magazine are examples of media releases concerning the topic at hand. Greater scholarly studies that draw from Canadian contexts are certainly warranted.

As introduced in the Problem Statement, another major drawback of the literature in this area of study was the lack of national work on the role of post-secondary instructors in

understanding and supporting the mental health of students. In other words, none have echoed the purpose of this study: to recognize instructors as potential key players in responding to the mental health needs of post-secondary students in Canada. International studies seemed to have

more frequently acknowledged the instructor’s role in this regard. Among the several, Kadison and DiGeronimo’s (2004) book, College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It, as well as Kay and Schwartz’s (2010) edited compilation, Mental Health Care in the College Community, are two noteworthy international sources that commented on the role of teaching faculty while considering student mental health in higher education settings. In particular, Silverman and Glick’s (2010) piece in Kay and Schwartz’s (2010) compilation looked more closely at the role of post-secondary educators, placing them as first line crisis responders and making suggestions on how they can address student mental health in the classroom. Although noteworthy, most international studies included only periodic or brief discussions of the roles faculty and staff play in relation to student mental health.In other cases, studies simply mentioned a need to consider this population in the future.

As similarly noted in CASA (2014), educator roles in relation to student mental health were more exclusively taken up in the literature that drew from elementary and secondary school contexts; three recent Canadian examples being Froese-Germain and Riel’s (2012) text,

Understanding Teacher Perspectives on Student Mental Health: Findings from a National Survey; Schonert-Reischel and Lawlor’s (2010) article, “The effects of a mindfulness-based education program on pre- and early adolescents’ well-being and social and emotional competence”; and Whitley et al.’s (2012) article, “Promoting mental health literacy among educators: critical in school-based prevention and intervention”. Considering their elemental presence in the daily practices of higher education institutions, post-secondary instructors can represent core and supplemental support providers for students with a mental health problem or illness, like educators in elementary and secondary school contexts.

Several drawbacks were also noted with how studies documented and presented practices that support the mental and well-being of students, whether or not these practices were

represented as employed by instructors in Canadian post-secondary institutions. Firstly, many studies presented initiatives as supportive of students with specific, identified, or “diagnosable” mental illnesses, such as depression, anxiety, and bipolar disorder (Cornejo, 2010; Davidson & Locke, 2010; Kay & Schwartz, 2010; Patton et al., 2000; Weisz, Sandler, Durlak, & Anton, 2005). This can be due to the prominence of quantitative, scientific studies that promote medically-defined categories of illness, rather than acknowledge mental health as part of a continuum. Mental illnesses can be stigmatized as more “threatening” than mental health

problems, which perhaps may encourage researchers to explore intervention possibilities that are primarily applicable to the former. Whatever the reason may be, the dominating focus on

diagnosed mental illnesses can leave a large number of students with mental health problems without recognition or support. That said, even in the literature that focused on specific, identified, or “diagnosable” mental illnesses, it seems that a handful of the more “popular” illnesses were covered; some common ones being, depression, anxiety, schizophrenia, and bipolar disorder (Cornejo, 2010; Davidson & Locke, 2010; Kay & Schwartz, 2010; Patton et al., 2000; Weisz, Sandler, Durlak, & Anton, 2005). Eating disorders, for example, can also be a component of mental illness, sometimes comorbid with depression or substance abuse, but these were rarely mentioned in the literature when reviewed. Again, a large number of students with a mental health problem or illness can go unrecognized when focus is on particular diagnosed concerns.

Secondly, research seemed overwhelmingly invested in assessing intervention outcomes; if and/or how recipients benefit from support (Reupert & Mayberry, 2010; Saunders, Evans, &

Joshi, 2005; Sharp et al., 2006; Stone et al., 2000). This was most notable in the quantitatively- designed, evaluation-based studies. There are two potential shortcomings in examining

intervention outcomes: a) intervention outcomes can be situational or temporal, which would make a determination in efficacy difficult to accomplish, and b) with evaluation studies focusing primarily on the individuals receiving support, the experiences or outcomes of those

promoting/providing support, such as classroom instructors, can be ignored (Han & Weiss, 2005). Indeed, an inquisition into intervention outcomes for post-secondary school students is fundamental (Davidson & Locke, 2010). However, considering the prematurity of many post- secondary mental health intervention systems, it seems necessary for researchers to first, or sometimes exclusively, concentrate on the intricate actions taken and conflict-laden realities experienced before and during the implementation of support (Munro & Bloor, 2010). Moreover, if and when outcomes are taken into consideration, the breadth of investigation can include the experiences and outcomes of multiple parties; those receiving and those providing support.

In turning to methodological limitations, a review of the literature confirmed that quantitative inquiry dominates this area of study (Alkin, 2004; Munro & Bloor, 2010; Sharp et al., 2006; Shaw, 2003; Shaw & Ruckdeschel, 2002; Tolma, Cheney, Troup, & Hann, 2009). In other words, qualitative exploration is a rare undertaking in studies that examine student mental health. Positivist paradigms and frameworks often prevail in quantitative research, leaving little room for social constructivist epistemology (Gephart, 1999; Gergen, 2013). As a result,

“discussions of personal experience, deeply held values, spiritual concern, political ideology, and aesthetic taste, for example, are simply irrelevant to the demands of the science qua science” (Gergen, 2013, p. 37). Put simply, subjective, ethnographic accounts of individuals outside the scientific research community are often unwelcomed. In relation to this area of study, the

perspectives of individuals affiliated with post-secondary schooling, including, but not limited to, teaching faculty, mental health professionals, and staff/administration, were under-represented in the literature that examined student mental health in higher education settings. Rather, studies generated data through experimental methods and standardized measurements carried out by university or hospital faculty researchers, indicating a dependency on the knowledge of professionals and institutions outside the field of education (Bibou-Nakou, 2004; Maryland School Mental Health Alliance, 2011). This was not surprising when considering the medicalized/scientific lens through which mental health topics are usually viewed and investigated.

Quantitative research that excludes the voices of individuals operating within academic settings has given way to several shortcomings in this area of study; one being a gap between theory and practice (Cornejo, 2010; Jaycox et al., 2006b; Reupert & Mayberry, 2010; Santor et al., 2009; Tinklin et al., 2005). Specifically, it seems difficult to understand practices that support the mental health and well-being of students in post-secondary institutions when data are taken from external contexts. How can knowledge regarding student mental health and intervention in higher education settings represent continuous, expansive, and multiple realities without the collection and analysis of subjective data from individuals directly associated with these environments, such as mental health professionals, instructors, or students with a mental health problem or illness? Along similar lines, how interventions are described versus how they are delivered remains uncertain when quantitative measures and “expert” voices are promoted (Foster-Fishman & Droege, 2010). The voices of post-secondary school mental health

professionals and/or instructors were rarely brought into conversation, rendering the capacity and readiness of higher education settings in facilitating interventions unclear. Faculty

unpreparedness would appear as a common occurrence considering the continuous gaps between theory and practice. According to Burns (2002), an interruption between system development and system delivery occurs because researchers place emphasis on the continuous development of new and innovative intervention ideas without investigating their level of execution. A qualitative approach to inquiry can help bridge the gap between development and delivery. Moreover, it offers the opportunity of using delivery as a means of informing development (Gergen, 2013).

Another shortcoming that came about in response to dominating positivist-based knowledge was a limited acknowledgment of the social, political, cultural, etc., factors or constructions that can influence mental health in higher education settings. The guide to a systemic approach towards post-secondary student mental health developed by CACUSS and CMHA (2014) was a noteworthy source that explicitly discussed the impacts of contextual factors, such as politics, culture, and socio-economic organization, on student well-being and whole-school approaches of support. Otherwise, these components or constructions were only briefly taken up in the few works that proposed or investigated whole-school approaches and systems of care (CACUSS & CMHA, 2014; Hanlon, 2012; UMCMHS, 2014). The social, political, cultural, etc., complexities that underlie other areas in relation to student mental health in higher education settings warrant greater consideration; for example, another area can include mental health stigma (CACUSS & CMHA, 2014; CMHA, 2014a). How is mental health stigma present within institutions? Is it through the language of academic documents or in the

vocabulary used by faculty and staff? What factors might be encouraging this stigma? According to Shaw and Ruckdeschel (2002), the moral and political dimensions of particular circumstances and settings can be effectively revealed through the qualitative approach of detailed contextual

analysis. As Lunenburg and Irby (2008) suggested, qualitative research “...emphasizes understanding by closely examining people’s words, actions, and records” (p. 89). More specifically, the process of qualitative inquiry works to uncover the individual and

shared/systemic meanings or constructions held within certain environments (Denzin & Lincoln, 2000). Capturing the ethnographic chronicles of post-secondary instructors can lead to a better understanding of the intricate and sometimes discreet conceptions surrounding mental health, such as stigma, that can influence practices of support.

On a positive note, recent scholarly inquiry is experiencing “a shift from an empiricist to a constructionist view of science… [where] age-old concepts of validity, accuracy, and

objectivity demand continuous reflection, and new concerns with such issues as responsibility, transparency, and relativity begin to invite debate” (Gergen, 2013, p. 42, 37). Put differently, more health-related studies have adopted methodologies rooted in qualitative inquiry. The literature review definitely revealed some studies that assumed a qualitative outlook, whereby descriptive narratives and informed discussions about mental health were shared (Browne et al., 2004; Corbin, 2005; Kearney & Bates, 2005; Jaycox et al., 2006b). The voices of students with mental health problems, including those who attend college and university, have been more frequently captured in response to this methodological shift (CACUSS & CMHA, 2014; CMHA, 2014; Martin, 2010). With respect to educators, however, the viewpoints of K-12 teachers were mainly represented (Anderson et al., 2007; Bibou-Nakou, 2004; CASA, 2014; Cornejo, 2010; Froese-Germain & Riel, 2012; Kidger et al., 2010). That said, the voices of post-secondary instructors were still limited, and even when highlighted sometimes, data was often “quantified” or drew from American contexts. The narratives of post-secondary administrators or mental health professionals were more often captured. In these cases, rather than the assumption of a

completely pluralistic posture, researchers seemingly returned to “commanding foundations” of quantitative inquiry, with the objective of including voices that promote rational, evidence-based data to establish pre-eminence (Gergen, 2013).

A substantive bulk of qualitative research that represents the viewpoints of Canadian post-secondary instructors in relation to student mental health seems necessary. Those “in situ” are quintessential in determining or reporting on the everyday functions within a particular context, or in other words, on the mental health policies and practices in post-secondary institutions. Hashimoto et al. (2010) suggest that, “to initiate [policies or practices] into an education system, capacity development of human resources, systems, and institutions at all levels is required (emphasis added)” (p. 104). The classroom is certainly a level of interest. In many cases, instructors can initiate support for students more often than mental health

professionals due to their constant presence in the classroom, which can give them multiple opportunities to assess the needs of students, and thereafter, exercise relevant practices of support (Han & Weiss, 2005; Schonert-Reichel & Lawlor, 2010). Additionally, limiting the voices of “experts” or “professionals” can encourage support practices that are less prescriptive, formulaic, or scientific in nature. Put differently, an assortment of voices can contribute to more holistic and inclusive approaches towards student mental health in post-secondary schools (Siggins, 2010). This can be seen, for example, through the several intervention applications and coalitions within Ontario elementary and secondary classrooms that resulted from a

consideration of teacher perspectives (Froese-Germain & Riel, 2012).

Along with the “missing voices” of classroom instructors, the literature review revealed that several qualitative studies have also excluded or vaguely included guiding theoretical models or frameworks (Burns & Hoagwood, 2002; Schonert-Reichl & Lawlor, 2010; Stone et

al., 2000). In some cases, the grounding of theory is considered unneeded when exploring human practices through a qualitative research methodology (Abraham, 2008). However, every topic of study can be conceived through multiple foci or “ways of knowing”, which may necessitate researchers to establish a primary guiding lens or theoretical framework. The explicit identification of a theoretical framework is particularly important in this area of research, as mental health is typically approached and understood through a medicalized perspective.

Therefore, without an indication otherwise, it can be assumed that studies in this area are guided by scientific models or frameworks. As such, research on mental health, even that which engages in qualitative, explorative inquiry, may continue to represent conventional or narrow

understandings in this area of study.

Drawing from a college institution situated in Toronto, Ontario, this study attempted to add to the currently small number of studies that have closely investigated student mental health at the post-secondary education level in Canada. Specifically, it sought to recognize the role of instructors in supporting the mental health and well-being of students; an undertaking not known to have yet been completed. Contrary to the quantitative, evaluation-based methodologies more commonly assumed in health-education research, this study examined the perspectives and practices of post-secondary instructors through a qualitative, constructivist lens. It situated instructor voices on the forefront. Doing so helped this study draw closer attention to the sometimes discreet and complex factors that influence mental health policy and practice in higher education settings; factors that can remain silenced or unnoticed, for example, when the ethnographies of post-secondary instructors are ignored.